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Refunds, Rebates, Deductibles and Other Wellness Incentives in Health Plans or Health Insurance Policies.

(a)It shall not be unlawful for an insurer to offer or sell, or for a broker, agent or solicitor on behalf of an insurer to offer or sell, a health plan or health insurance policy which provides for a refund or rebate of premium or deductible, a discounted copayment or other wellness incentive in a health plan or health insurance policy, provided, that any such valuable consideration or reward is specified in the plan or policy, and further provided, that the plan or policy complies with the Final Rules for Nondiscrimination and Wellness Programs promulgated under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), which provide an express exception to the general rule prohibiting discrimination on a health factor if the reward is based on participation in a wellness program of health promotion or disease prevention.

(b)It shall not be unlawful for an insurer to pay a refund or rebate of premium or refund a deductible to an insured or discount a co-payment under a health plan or health insurance policy, provided, that the amount of such payment complies with limitations and restrictions set forth in HIPAA and the Final Rules for Nondiscrimination and Wellness Programs promulgated under HIPAA.

(c)It is unlawful for any insurer or general agent to appoint an agent for the purpose of enabling such agent, or other person, to obtain at a cost less than that specified in the policy any insurance from such insurer.

(d)The provisions of this Section and the requirement of a wellness program under the exception to the HIPAA’s general rule against discrimination shall not be applicable to any health plan or health insurance policy which does not discriminate against any individual on any health factor or otherwise violate the general rule. Refunds of premiums, deductibles (including pre-funded COL 1/26/2024 CH. 15 BUSINESS OF INSURANCE deductibles) or co-payments which are uniformly applied to all similarly situated insureds are not rewards based on a health factor, and are therefore not in violation of the general rule.